PMID- 33452045
OWN - NLM
STAT- MEDLINE
DCOM- 20230224
LR  - 20230224
IS  - 2045-4368 (Electronic)
IS  - 2045-435X (Linking)
VI  - 13
IP  - 1
DP  - 2023 Mar
TI  - Subcutaneous furosemide in advanced heart failure: service improvement project.
PG  - 112-116
LID - 10.1136/bmjspcare-2020-002803 [doi]
AB  - OBJECTIVES: In severe heart disease, parenteral administration of loop diuretic 
      is often needed. We present clinical outcomes from episodes of care using 
      subcutaneous continuous subcutaneous infusion of furosemide (CSCI-furosemide). 
      METHODS: Retrospective review of service improvement data. The heart failure 
      nurse specialist, supported by the heart failure-palliative care 
      multidisciplinary team, works with the community or hospice staff who administer 
      the CSCI-furosemide. Data collected for consecutive patients receiving 
      CSCI-furosemide included: age, sex, New York Heart Association (NYHA) class, 
      preferred place of care, goal of treatment, infusion-site reactions, and signs 
      and symptoms of fluid retention (including weight and self-reported 
      breathlessness). RESULTS: 116 people (men 86 (66%); mean age 79 years, 49-97; 
      NYHA class 3 (36/116, 31%) or 4 heart failure (80/116, 69%)) received 130 
      episodes of CSCI-furosemide (average duration 10 days, 1-49), over half in the 
      patient's own home/care home (80/129,; 61%) aiming to prevent hospital admission. 
      40/129 (31%) were managed in the hospice, and 9 (7.0%) in a community hospital. 
      Average daily furosemide dose was 125 mg (40-300 mg). The goal of treatment was 
      achieved in (119/130, 91.5%) episodes.The median reduction in weight was 4 kg 
      (IQR -7 to -2 kgs, -22 to 9 kgs). Self-reported breathlessness reduced from 8.2 
      (+/-1.9) to 5.2 (+/-1.8). Adverse events occurred in 31/130 (24%) episodes; all but 
      4/130 (3%, localised skin infection) were mild. CONCLUSIONS: These preliminary 
      data indicate that CSCI-furosemide is safe and effective for people with severe 
      heart failure. An adequately powered randomised controlled trial is indicated.
CI  - (c) Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Birch, Francesca
AU  - Birch F
AD  - Wolfson Palliative Care Research Centre, Hull York Medical School, University of 
      Hull, Hull, UK.
FAU - Boam, Emily
AU  - Boam E
AD  - Wolfson Palliative Care Research Centre, Hull York Medical School, University of 
      Hull, Hull, UK.
AD  - Health Education England Yorkshire and the Humber, Leeds, UK.
FAU - Parsons, Sharon
AU  - Parsons S
AD  - Humber Mental Health Teaching NHS Trust, Willerby, East Riding of Yorkshire, UK.
FAU - Ghosh, Justin
AU  - Ghosh J
AD  - York Teaching Hospital NHS Foundation Trust, York, North Yorkshire, UK.
FAU - Johnson, Miriam J
AU  - Johnson MJ
AUID- ORCID: 0000-0001-6204-9158
AD  - Wolfson Palliative Care Research Centre, Hull York Medical School, University of 
      Hull, Hull, UK miriam.johnson@hyms.ac.uk.
LA  - eng
PT  - Journal Article
DEP - 20210115
PL  - England
TA  - BMJ Support Palliat Care
JT  - BMJ supportive & palliative care
JID - 101565123
RN  - 7LXU5N7ZO5 (Furosemide)
RN  - 0 (Diuretics)
SB  - IM
MH  - Male
MH  - Humans
MH  - Aged
MH  - Furosemide/therapeutic use
MH  - *Heart Failure/complications/drug therapy
MH  - *Hospice Care
MH  - Palliative Care
MH  - *Hospices
MH  - Diuretics/therapeutic use
MH  - Treatment Outcome
OTO - NOTNLM
OT  - drug administration
OT  - heart failure
OT  - service evaluation
OT  - symptoms and symptom management
COIS- Competing interests: None declared.
EDAT- 2021/01/17 06:00
MHDA- 2023/02/25 06:00
CRDT- 2021/01/16 05:32
PHST- 2020/11/13 00:00 [received]
PHST- 2020/12/14 00:00 [revised]
PHST- 2020/12/16 00:00 [accepted]
PHST- 2021/01/17 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2021/01/16 05:32 [entrez]
AID - bmjspcare-2020-002803 [pii]
AID - 10.1136/bmjspcare-2020-002803 [doi]
PST - ppublish
SO  - BMJ Support Palliat Care. 2023 Mar;13(1):112-116. doi: 
      10.1136/bmjspcare-2020-002803. Epub 2021 Jan 15.